Types and correlates of blood/injury-related vasovagal syncope

This study investigated by interview, the initial syncopal episode of 103 blood/injury-related vasovagal fainters in order to examine two competing hypotheses concerning their origins. Graham (Circulation, 23, 901-906, 1961) postulated that the faint resulted when sympathetic nervous system (SNS) activity ceased on termination of a threat, leaving parasympathetic nervous system (PNS) activation unopposed. Engel [Fainting (2nd edn), 1962; Annals of Internal Medicine, 89, 901-906, 1978] proposed that when in the face of threat with SNS activation, escape is blocked, the PNS becomes activated as the conservation-withdrawal response, leading to syncope. We found cases clearly conforming to each of these formulations as well as some with characteristics of both, and some who fainted in response to blood or injury but with no perception of threat. The Graham and Engel types did not differ in terms of fear or avoidance of blood, injury, or medically-related situations nor did they differ in the frequency with which their parents reported blood/injury-related syncopal episodes. It is proposed that both may be activated by a common psychological mechanism involving cessation of a defensive posture. In contrast, the non-threat fainters showed significantly less medically-related avoidance and had a greater percentage (94%) of parents with positive faint histories.     

Neurosteroids in the Hippocampus: Neuronal Plasticity and Memory

The hippocampus, which is critically involved in learning and memory processes, is known to be a target for the neuromodulatory actions of steroid hormones produced by the adrenal glands and gonads. Much of the work of B.S. McEwen and collaborators has focused on the role of glucocorticosteroids and estrogen in modulating hippocampal plasticity and functions. In addition to hormones derived from the endocrine glands, cells in the hippocampus may be exposed to locally synthesized neurosteroids, including pregnenolone, dehydroepiandrosterone and their sulfated esters as well as progesterone and its reduced metabolites. In contrast to hormones derived from the circulation, neurosteroids have paracrine and/or autocrine activities. In the hippocampus, they have been shown to have trophic effects on neurons and glial cells and to modulate the activity of a variety of neurotransmitter receptors and ion channels, including type A gamma-aminobutyric acid, N-methyl-D-aspartate and sigma receptors and N- and L-type Ca2+ channels. There is accumulating evidence that some neurosteroids, in particular pregnenolone sulfate, have strong influences on learning and memory processes, most likely by regulating neurotransmission in the hippocampus. However, the hippocampus is not the only target for the mnesic effects of neurosteroids. Associated brain regions, the basal nuclei of the forebrain and the amygdaloid complex, are also involved. Some neurosteroids may thus be beneficial for treating age- or disease-related cognitive impairments.     

Acquisition of blood, injury, and needle fears and phobias

The origins of fear and phobia of blood, injury, and injections were investigated in a sample of 128 fearful university students. Based on Mutilation Questionnaire scores, subjects were designated as common fear, high fear, or phobic. Ss reports of their onset experiences obtained from structured interviews were categorized into one or more acquisition pathways of conditioning, vicarious observation, and information. Of the 73% of Ss who recalled one or more onset experiences, 76% reported conditioning-like events as the primary pathway with the majority reporting fear-related UCSs. Vicarious experiences were reported as primary by 20% and 3% reported information as being primary in their fear onset. Severity of fear was unrelated to the pathway by which it was acquired, to whether the onset was recalled, and if recalled, whether it was due to a single or to multiple traumatic events. Results are discussed in terms of methodological problems of memory issues and means by which data are collected.     

A Cross-Cultural Comparison of Social Phobia Symptoms

This study examined two forms of social anxiety or phobia, social phobia as defined by DSM-IV and Taijin Kyofusho (TKS, a Japanese form of social anxiety), in relation to their respective culturally prescribed self-construals as independent and interdependent. Japanese university students (N = 124) and U.S. university students (N = 123) were administered the Social Interaction Anxiety Scale, the Social Phobia Scale, the TKS Scale, and the Self-Construal Scale. From the results of a hierarchical regression analysis, TKS symptoms are more likely to be expressed by individuals who are Japanese and individuals who construe themselves low on independence but high on interdependence. In addition, social phobia symptoms are more likely to be expressed by individuals who construe themselves low on independence but high on interdependence irrespective of culture. Implications for therapists from each culture who have clients who present social anxiety or phobia symptoms are discussed.     

A Study of Panic Attacks in University Students of Iran

This study examined the parameters of panic, fear, and avoidance among university students in Iran. Data were collected from 347 students using Farsi translations of the Panic Attack Questionnaire, Beck Depression Inventory, Taylor Manifest Anxiety Scale, State-Trait Anxiety Inventory, and Anxiety Sensitivity Index. Thirty-eight percent of participants reported panic attacks in the past year and 21.4% reported panic attacks in the past 4 weeks when prompted by a broad definition of panic. Men and those with unexpected panic reported greater panic severity whereas women with panic attacks reported greater situational fear and avoidance. Panickers who satisfied DSM-III-R panic disorder (PD) criteria reported greater lifestyle restriction and general psychopathology. The findings provide tentative support for cross-cultural similarity in panic phenomenology and the validity of DSM-III-R PD criteria among university students in Iran. The results are discussed by reference to nonclinical panic research and general themes of Iranian culture.     

Blood/injury fear, fainting and avoidance of medically-related situations: a family correspondence study

The relationship of mutilation fear and fainting was examined in 204 students, (103 fainters and 101 non-fainters) by administering a series of questionnaires and a structured interview concerning the history, effects and circumstances of their fear and fainting. Two hundred and sixty of their parents completed the same scales along with a self-report version of the structured interview. Subjects were classified according to their fainting status and level of fear based on Mutilation Questionnaire scores, as phobic, fearful, and non-fearful fainters, and fearful non-fainters. Phobic and fearful fainters avoided significantly more medical and related situations due to their fear and fainting than fearful non-fainters and non-fearful fainters. Medical avoidance was best predicted by a linear combination of subjects' estimated probability of future fainting and number of past faint episodes. More females reported fainting and females reported greater fear, but they did not differ from males in fear-motivated avoidance of medical situations. A significant parent-child correspondence was found for fainting, but not for fear nor for avoidances. Implications of these findings for fear and fainting acquisition and its relation to avoidance were discussed.     

The origins and remission of fear in a group of tarantula enthusiasts

Members of a tarantula interest group were surveyed concerning their present and past attitudes and fears of tarantulas. Those who had been fearful but were no longer so, were asked how they acquired their fear and how they overcame their fear. A comparison group of equivalent sex and age distribution was also surveyed. Subjects' reports indicated that of the 51% of the tarantula group members and the 70% of the comparison group who reported fear, the major sources ofthat fear were media information (61%) and interpersonal/vicarious communication (34%). Among those previously fearful but who overcame their fear, 70% attributed fear reduction to acquired knowledge of tarantulas or spiders, 40% to observation and 27% to direct physical contact. These results are discussed in terms of fear acquisition mechanisms and processes by which fears remit without professional treatment.